Healthcare Provider Details

I. General information

NPI: 1558557215
Provider Name (Legal Business Name): ELLEN YASS-REED, M.A. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 CHAMBER CENTER DR
LAKESIDE PARK KY
41017-1669
US

IV. Provider business mailing address

2128 CHAMBER CENTER DR
LAKESIDE PARK KY
41017-1669
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-6525
  • Fax: 859-331-6526
Mailing address:
  • Phone: 859-331-6525
  • Fax: 859-331-6526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberKY 0018
License Number StateKY

VIII. Authorized Official

Name: MS. ELLEN M YASS-REED
Title or Position: PSYCHOLOGICAL PRACTITIONER
Credential: M.A.
Phone: 859-331-6525